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A leading provider-owned health plan was unable to expand its product lines and create new care delivery models due to a lack of flexibility in its 20-year-old system. The system did not have a Medicare module or the ability to support health benefit exchanges. Moreover, it could neither provide real-time benefit encounter updates nor automatically manage bundled payments for procedures or value-based reimbursements. It also had limited capacity for claims automation. In addition to being increasingly expensive to operate, the existing system limited the health plan’s ability to embrace new digital capabilities.
After reviewing an array of systems, the health plan chose Cognizant’s TriZetto® Facets® core administration platform to support its almost 600,000 members.
Cognizant brought an array of expertise to the project. Dedicated program management, data migration, onshore and offshore quality assurance, offshore system integration, education services, consulting, process management optimization, configuration, product, architecture and optimization specialists all helped ensure a smooth implementation. We also helped the health plan reimagine key business processes to take full advantage of the new platform’s capabilities. It is currently exploring how robotic process automation can further amplify the platform’s efficiencies.
The advanced and broad functionality of our TriZetto Facets core administration platform was especially attractive to our client as it met most of the health plan’s needs. The plan also took advantage of the pre-integrated TriZetto® NetworX Pricer® and TriZetto® Elements® solutions. These strategic, best-in-class Cognizant TriZetto Healthcare Products helped the health plan stand out in the market and create a competitive advantage. With its extensive automation capabilities, strong compliance features and streamlined processing, Facets perfectly aligned with the health plan’s long-term strategic goals. In addition, our platform provided the health plan with the flexibility to quickly adapt to the changes in the industry.
on-time submissions to Centers for Medicare & Medicaid Services
provider payment accuracy
into new markets while achieving full compliance with regulatory requirements
increase in the plan’s auto-adjudication rate
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